Healthcare Provider Details

I. General information

NPI: 1568892727
Provider Name (Legal Business Name): ALISA DANAE MITCHELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 W SUNSET AVE STE D
SPRINGDALE AR
72762-4974
US

IV. Provider business mailing address

24189 FALLING SPRINGS RD
GENTRY AR
72734-9006
US

V. Phone/Fax

Practice location:
  • Phone: 501-205-4570
  • Fax:
Mailing address:
  • Phone: 903-701-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2022013920
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2007034
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: